Management of type 2 diabetes requires a multifaceted approach to achieve optimum results. Ideally, this includes patient engagement, peer support, care coordination, and patient self-management. However, incorporating all of these factors into each patient care experience can be difficult, especially when one considers that this patient population is growing rapidly and only so many patients can be seen in a day.

Two methods have been proposed, which address separate parts of this issue. The first is shared medical appointments (SMA). An SMA is a research-validated group appointment method that helps to stimulate peer support and alleviate some of the time constraints inherent in individual appointments. The second is personalized health planning (PHP), which emphasizes patient engagement in creating and achieving personal health-related goals. It was hypothesized that these two methods would be complementary and that combining them will produce a significantly better patient satisfaction and participation when compared to either one alone.

A randomized controlled trial was selected for the study design, as the researchers wished to determine causation of any potential observed benefit. Of which, the primary goal was to determine the feasibility of combining SMA with PHP, assessed via patient attendance and satisfaction. Effect of SMA – PHP combination on clinical and patient reported outcomes were assessed secondarily. Participants were recruited from the Duke Family Medicine Center. Patients were eligible to participate if they were at least 18 years of age with a diagnosis of type 2 diabetes and an HbA1c of > 7.0% taken within the last year. Exclusion criteria consisted of: pregnancy, diagnosis of type 1 diabetes, receiving dialysis, or having a history of amputation. Once deemed eligible, participants were randomized into either the control group (receiving SMA alone) or the intervention group (receiving a combination of PHP and SMA). SMA sessions were 120 minutes in length and occurred on a monthly basis for a total of eight appointments. They consisted of gathering individual health information (vitals, medication reconciliation, and medication adjustment) followed by group education and discussion. The PHP – SMA combination sessions were similar in duration and frequency but differed in that they emphasized shared goal setting, personal health plans, and a more structured process of health self-assessment. The primary objective was evaluated via overall attendance and satisfaction scores (documented with a 6-point Likert scale at the end of the final session). Secondary outcomes were assessed with physical and laboratory assessment (BMI, HbA1c, blood pressure, and LDL), as well as questionnaires (taken at baseline and post intervention).

In total, 19 patients were deemed eligible and randomized into their respective groups (7 in the SMA group and 12 in the PHP – SMA group). The study data demonstrated that the participants who were enrolled in the combination PHP – SMA group were more likely to attend follow-up meetings than those in the SMA group (58% and 28.5% respectively). Those in the intervention group also reported high levels of satisfaction with the program (5.3 on a 6-point Likert scale). Statistically significant improvements in blood pressure, depressive symptoms, HbA1c, and cholesterol were also noted in the intervention group when compared to baseline. It should also be noted that due to low enrollment and high dropout, the control group provided little basis for comparison for the secondary outcomes.

The results of this study are promising in that they illustrate, in the very least, an increased willingness to attend PHP – SMA combination meetings when compared to SMA meetings. Increased attendance translates to increased opportunities for meaningful intervention. However, this study had low enrollment; thus, further research is required to validate the findings reported and conclusions drawn therein.

Practice Pearls:

Both SMA and PHP are research-validated methods of improving patient care and engaging patients in the management of their chronic disease. However, they focus on different aspects of the patient care process.

A combination of PHP and SMA appears to increase the likelihood of patient attendance over SMA meetings alone. This may increase the opportunity for meaningful intervention.

Due to low enrollment and high dropout in the control group, further research is necessary to validate the findings of this study.